The healing art of medicine was taught and practiced before written records were kept. This chapter describes the science and practice of medicine from the earliest evidence of healing, when disease was considered to be of supernatural origin, to the present— a time of astounding research, discovery, and healing. Contributions of many ancient peoples still influence medicine today. The discussion of present-day medical codes of ethics, rules pertaining to sanitization, personal hygiene, herbal cures, acupuncture, and other medical and surgical practices highlights the specific contributions of early medicine and those whose accomplishments catapulted the science of medicine into the amazing field that it is today.
Hippocrates: Father of Western Medicine The first scientific system of medicine in the Western world originated in ancient Greece. It is usually associated with Hippocrates (460–377 BC), who is known as the Father of Western Medicine. Hippocrates took medicine from the realm of mysticism and philosophy and transformed it into an area of scientific discovery and practice. He stressed the body’s healing nature, formed clinical descriptions of diseases, and discovered the ability to identify some diseases by listening to the chest. He practiced medicine at a time in history when little was known about anatomy and physiology. Nevertheless, his writings and descriptions of symptoms remain accurate today.
The Hippocratic Oath (Box 2-1) is part of the writings of this ancient physician. The oath serves as a widely used
ethical guide for physicians who pledge to work for the good of the patient, to do the patient no harm, to prescribe no deadly drugs, to give no advice that could cause death, and to keep confidential medical information regarding the patient. The oath is still often cited as part of graduation ceremonies in medical schools.
Medicine During the Twentieth Century Major medical advances occurred during the first half of the twentieth century. Death rates from diseases such as tuberculosis and diphtheria dropped dramatically. Overall mortality rates decreased because of improved medical care, and new emphasis was placed on morbidity rates (rates of disease and illness). Four major developments dominate this period:
• The specialty of oncology, the study and treatment of cancer, with the development of chemotherapy
• The development of immunology, the study of the immune function
• Progress in endocrinology, the study of glands and their functions
• Progress in nutrition, understanding the requirements of vitamins, minerals, and food in the body
Women in Medicine Few women were allowed to practice medicine in the early years. In part, this was due to social constraints on women appearing in public. However, many women did practice as midwives and became skilled at delivering babies. Some remarkable female physicians and nurses overcame great odds to practice in their profession.
Florence Nightingale Florence Nightingale (1820–1910) is considered the founder of modern nursing. She studied nursing in Europe and cared for wounded soldiers during the Crimean War (1850–1853). Nightingale and her fellow nurses were treated poorly by the doctors at that time. Nightingale’s attention to detail, record keeping, and compassionate nursing care changed the way nursing was practiced. She advocated the use of the nursing process and elevated nursing to an honored profession. She is referred to as “The Lady with the Lamp” because of her tireless work night and day to supervise the nursing care of wounded soldiers. She started the first school of nursing in 1860 at St. Thomas Hospital in London.
Modern Medicine and the Future In the past 25 years, technological discoveries have permitted medical science to advance faster than in the previous 100 years. The twenty-first century holds the potential for even greater advances. The average life span of ancient humans was 30 years. According to the U.S. Census Bureau in 2001, a person born in 1900 had the life expectancy of 47 years, and someone born in 1991 had the life expectancy of 76 years. In 2008, the census bureau estimated that by the year 2020 the projected life expectancy will average 79.5. With rapid medical advancements, some estimate a life expectancy of 100 years will be possible. Recent advances include the following: • Improved communication techniques now allow patients’ results to be examined by physicians across the country. • Robotics is routinely used during forms of surgery. • It is common to have patients undergo surgery to successfully replace knees, hips, kidneys, and corneas; procedures that were unheard of and inconceivable less than 100 years ago. The future of medical science in the twenty-first century is vast.
MEDICAL PRACTITIONERS
The medical-assistant training and skills that you receive will enable you to work for physicians who practice in a variety of specializations. As a medical assistant, you will also encounter many allied health professionals from a wide range of fields. It is important that you understand and respect the role and educational requirements of others as you work alongside them in the field of health care. In this section, we discuss different types of credentials for those practicing medicine. Areas covered include fields of practice as well as educational requirements for medical doctors, osteopaths, and chiropractors. Title of Doctor The title of doctor designates a person who holds a doctoral degree. Commonly “doctor” refers to a medical doctor (an MD) or a doctor of osteopathic medicine (DO). The practice of medicine, which is the science of diagnosis, treatment, and prevention of disease, requires a minimum of nine to ten years of education and training, which generally includes a four-year college degree in premedical studies, four years of medical school, and a period of residency.
Types of Medical Practices In the early twentieth century, the main form of medical practice was the solo practice in which a family practitioner set up a medical practice within a designated town or geographic area. Solo practices are becoming less popular as a result of increased costs, changes associated with practicing medicine, and the legal environment associated with managing a solo practice. Other forms of medical practice that can meet patients’ needs for around-the-clock medical coverage have become popular. Alternative types of medical practices also provide the opportunity for a group of physicians to share insurance premium costs, staff, and investments in facilities.
Solo Practices
Partnership or Associate
Group
Corporation
Medical Specialties
Allergy and Immunology
Anesthesiology
Bariatrics
Cardiology
Dermatology
Emergency medicine
Endocrinology
Family Practice
Gastroenterology
Geriatric Medicine
Hospitalist
Internal Medicine
Nephrology
Neurology
Nuclear Medicine
Obstetrics and Gynecology
Oncology
Ophthamology
Orthopedics
Otorhinolaryngology
Pathology
Pediatrics
Podiatry
Psychiatry
Pulmonology
Urology
Surgery
Surgical Specialties
Health Care Facilities
Hospitals
The hospital is still considered the key resource for health care in the United States. Although acute care is primarily performed in a physician’s office, a hospital is the site of care for major surgical procedures and other major health care services.
To ensure quality health care, many hospitals seek accreditation. The Joint Commission (TJC), formerly the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), is a private nonprofit organization that encourages high standards of medical care. Strict guidelines must be met by the institution seeking accreditation.
Historically, all surgeries were performed in hospitals, but the modern trend is for minor surgical procedures to be performed in freestanding or hospital-based outpatient surgical centers. Surgical procedures performed in outpatient centers generally require very little recovery time. In this setting the medical assistant can assist the patient with scheduling and preparing for surgery, receive and admit the patient, assist with some surgeries, and discharge the patient with postoperative instructions. Urgent Care Centers Because of a need for quick care in nonemergent situations, a variety of freestanding and hospital-based urgent care centers have been established. The urgent care center treats nonemergent but urgent situations, such as performing sports physical examinations, setting fractures, drawing blood for blood tests, treating infections, and providing care at times other than during the usual physician office hours. Some of these centers are also designated as primary care facilities in a specific managed care system. Because of the quick assessment and treatment they provide, these centers are popular for workers’ compensation cases and occupational medicine coverage for many companies.
Types of Long-Term Care Institutions Long-term care institutions are classified by federal regulations either as skilled nursing facilities (SNF), intermediate care facilities (ICF), or extended care facilities (ECF).
ALLIED HEALTH PROFESSIONALS
It would be impossible in this single chapter to cover all of the many health care professions. Yet as a member of the health care team, it is essential that you understand the roles and educational requirements of other health care professionals. It is also important to understand how, specifically, a medical assistant will work alongside and relate to other professionals in the field. Before we consider some specific professions, you will need an understanding of the terms certification, registration, and licensure as well as levels of education and degree titles as they relate to allied health professionals. Education and Credentials Educational requirements for health careers vary from state to state. In all cases, a high school diploma or equivalency is necessary. Postsecondary education in a vocational/technical school, community college, or university may be required. Table 2-3 illustrates a career ladder in health care, educational requirements, degree designations, and some examples of professions in each category. Health care institutions may require the applicant to pass a national registration or certification examination in his or her field of study as a condition of hire. Certification involves the issuing of a certificate and credentials by a professional organization to an individual who has met the educational and experience standards of that organization, and has passed a certification exam. Certifying agencies for the field of medical assisting are discussed in the chapter titled “Medical Assisting: The Profession.” Registration means that a professional organization in a specific health care field administers examinations, maintains a list of qualified individuals, or both. Licensure means that a government agency, usually a state agency, authorizes individuals to work in a given occupation, such as registered nurses (RN), licensed practical nurses (LPN), and physical therapists (PT).
Professionalism
Physicians must obtain continuing education to retain their license. Medical assistants also need to keep abreast of new medical information. The AAMA requires Certified Medical Assistants (CMAs) to earn 60 continuing education credits (CEUs) in five years to maintain their certification. Registered Medical Assistants (RMAs) who earn certification by passing the American Medical Technologists’ examination must also comply with the continuing education requirements outlined in the AMT Certification Continuation Program (CCP). The CCP program requires acquiring a certain number of points, which can be obtained through continuing education or other acceptable avenues. Being a lifelong learner should be the goal of every medical assistant. The body of knowledge in health care is growing tremendously each year, and you will need to be vigilant about keeping up with new information. The following are a few ideas to help you become a well-informed, lifelong learner: • Read CMA Today, the AAMA medical assisting journal, or AMT Events, the RMA professional publication, and complete the continuing education articles and tests provided in each publication. • Select an interesting condition or disease each month to research on the Internet or at your local library. Keep this research information in a binder for future reference. • Subscribe to other medical publications, or ask your physician employer if you may read some periodicals that she receives. • Attend seminars provided by the local hospital, HMO, and state or local chapters of medical assisting groups.
Therapeutic Cluster Careers Careers in this therapeutic cluster include those that relate to the health care status of patients, including treatment, evaluation, collection of patient data, and evaluation of patient status. Medical assistants often have a direct relationship with professionals in the therapeutic cluster.
Nurse The term nurse refers to a diversified group of health care professionals with a range of qualifications. Medical assistants work alongside nurses in a variety of health care settings. In some cases, a nurse may work as a direct clinical supervisor to a medical assistant. However, it is important to understand your state laws regarding the delegation of specific duties to a medical assistant. Descriptions of a certified nursing assistant (CNA), licensed practical nurse (LPN), registered nurse (RN), and nurse practitioner (NP) follow. Certified Nursing Assistant (CNA). A certified nursing assistant is a member of the health care team who has completed a training program and has passed a state-issued examination, which allows the individual to assist nurses in nursing homes, hospitals, and other health care facilities. The CNA provides such patient care as bed baths, measuring vital signs, feeding, and ambulation. Cross-training of employees has led to positions such as patient care technician (PCT). The PCT may have a CNA or medical assisting background and perform more technical tasks, such as drawing blood and performing ECGs. The nursing assistant may also be referred to as a nurses’ aide or orderly. Licensed Practical Nurse (LPN). A licensed practical nurse performs some, but not all, of the same clinical nursing tasks a registered nurse does. The LPN must have graduated from a recognized one-year program and become licensed by the National Federation of Licensed Practical Nurses. In some states, the LPN is known as a licensed vocational nurse (LVN). Registered Nurse (RN). A career as a registered nurse is ideal for the person who wishes to provide hands-on patient care. Nurses work in hospitals, physicians’ offices, industry, governmental agencies, ambulatory care units, emergency services, and schools. Their work ranges from managed care organizations providing direct patient care, to teaching and supervising other staff, performing research, and managing agencies. Nurses receive their education and training in either a two-year or a four-year program. To become licensed as an RN requires successful completion of the National Council Licensure Examination (NCLEX), a national licensure examination. A nurse practitioner (NP) is a registered nurse who has a master’s degree and has received additional training to provide basic patient care that includes diagnosing and prescribing medications and treatments for common illnesses.
Occupational Therapist (OT) Occupational therapy provides treatment to people who are physically, mentally, developmentally, or emotionally disabled. Occupational therapists evaluate the patient’s skills for self-care, work, and leisure. The goal of the occupational therapist is to develop programs that will help to restore the patient’s ability to manage activities of daily living (ADL). Occupational therapists require a bachelor’s degree from an approved program in occupational therapy, plus certification by the American Occupational Therapy Association (AOTA) and six months of on-the-job training.
Physical Therapist (PT) Physical therapy is the treatment of diseases or disabilities of the joints, bones, and nerves by massage, therapeutic exercises, and heat and cold treatments. Examples of conditions treated by means of physical therapy include multiple sclerosis, cerebral palsy, arthritis, fractures, spinal cord injuries, and heart disease. Practitioners work in a variety of facilities including hospitals, ambulatory care centers, rehabilitation centers, private practice, and schools for the physically challenged. A PT is required to hold a four-year degree in physical therapy, participate in a four-month clinical internship, and successfully pass the state licensure examination. After obtaining a master’s degree, some PTs set up private practices and provide services on a contract basis.
Physician Assistant (PA) The field of physician assistant is relatively new, emerging only since the 1970s. The goal of this professional is to assist the physician in the primary care of patients. The job description for a PA includes evaluation, monitoring, diagnosis, therapeutics, counseling, and referral skills. In nearly all states, the PA can prescribe medications. The profession has expanded to include surgeon’s, pathologist’s, anesthesiologist’s, and radiologist’s assistants, among others. The general educational program is similar to a master’s-level program with two years of education after a bachelor’s degree. In most programs, the student must have some combination of work or internship experience and pass an accreditation examination.
Respiratory Therapist (RT) A respiratory therapist evaluates, treats, and cares for patients with breathing problems. A respiratory therapist tests lung capacity, administers breathing treatments, teaches self-care to patients, and provides emergency care. An RT can be employed in hospitals, cardiopulmonary laboratories, nursing homes, health maintenance organizations (HMOs), and ambulatory care facilities. To become a certified respiratory therapy technician (CRTT), the candidate must complete a one-year internship and pass a written examination given by the National Board of Respiratory Therapy.
Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced Emergency Medical Technician (AEMT), and Paramedic There are four levels of Emergency Medical Services (EMS) training and certification as designated by the U.S. Department of Transportation. EMS providers are skilled in recognizing and responding to trauma and medical emergencies and providing emergency care and transport to a medical facility. Each state has its own laws governing EMS. EMTs and paramedics work under the license and supervision of a physician.
Diagnostic Cluster Careers The careers in this cluster are involved with procedures that create a picture of the patient’s health status at a specific point in time. These careers involve measuring, evaluating, and reporting patient information. Depending on the employment setting, medical assistants may have limited interactions with professionals in the diagnostic cluster of careers. In some states, medical assistants have the opportunity to take additional classes in order to become a general X-ray machine operator (GXMO) or a limited X-ray machine operator (LXMO). These MAs could have the opportunity to work closely alongside some of the following professionals in diagnostic imaging facilities or clinics and hospitals. Ultrasound Technologist An ultrasound technologist receives training in the use of ultrasound equipment, which uses inaudible sound waves to outline shapes of tissues and organs. Ultrasound equipment produces an image of the shapes. Ultrasound images of fetal development in the uterus are commonly used to assist with fetal monitoring.
X-ray Technologist (Radiologic Technologist) An X-ray, or radiologic, technologist must hold a bachelor’s degree in radiologic technology, have experience in two or more radiologic disciplines, such as nuclear medicine and radiation therapy, and be a registered radiologic technologist (ARRT). Electroencephalograph Technician Electroencephalography (EEG) is the field devoted to recording and studying the electrical activity of the brain. An EEG technician operates an electroencephalograph, which records the activity of the brain with a written tracing of the brain’s electrical impulses. EEG technologists work primarily in hospitals. Diagnostic Imaging Technician Diagnostic imaging technicians are trained in the operation of X-ray equipment such as ultrasound, computerized tomography (CT), and magnetic resonance imaging (MRI) equipment. Radiology practitioners include darkroom attendants, who require only a minimum amount of education or training; radiologic technicians, who are graduates of an accredited postsecondary education program and have passed a certification exam in their field; and radiologists, who are licensed physicians who have graduated from an accredited medical school with specialized training in radiology. Employment opportunities are available in physicians’ offices, hospitals, trauma centers, and other ambulatory care facilities. Medical Laboratory Careers A medical laboratory is a facility that is equipped for testing, research, scientific experimentation, or clinical studies of materials, fluids, or tissues taken from patients. Independent laboratories provide routine analysis of patients’ blood, urine, tissue, and other materials. Hospital laboratories perform tests for both inpatients and outpatients. In some instances, a physician’s office will contain a small physician office laboratory (POL) where routine tests can be conducted.
Phlebotomist or Venipuncture Technician. A phlebotomist is skilled in drawing blood from patients. This requires the ability to adhere to standard precautions, aseptic technique, excellent venipuncture technique, and good communication skills.
Information Services Cluster Careers Careers in this cluster are involved with documenting client information, including managing, coding, analyzing, maintaining, and retrieving information. Medical assistants will work very closely with professionals in this career cluster. A medical assistant will contact a medical records technician many times throughout the work week in order to obtain the most up-to-date records for their patients.
Many times, a medical assistant may work as an office manager for a medical practice, or become employed as a unit clerk at a hospital or clinic.
Medical Records Technician, Medical Transcriptionist , Office Management, Unit clerk, or ward secretary.
Professional Educational Requirement Diploma/Degree Examples: Professional -Four-year degree, advanced degree, and clinical training Bachelor’s (BA, BS), master’s, or doctorate – Medical Doctor (MD), Pathologist
Technologist Four-year college program Bachelor’s (BA, BS) Medical Technologist (MT) Technician -Two-year community college or vocational program -Associate’s degree (AS)- Medical Laboratory Technician (MLT)
Assistant Up to one-year classroom and clinical preparation- Diploma -Laboratory Assistant
Aide On-the-job -training High school diploma or GED- Laboratory Aide